Inspection on 03/09/07 for Whittingham House

This inspection was carried out on 3rd September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Whittingham House 06/01/10

Whittingham House 27/01/09

Whittingham House 29/02/08

Whittingham House 17/11/06

Whittingham House 18/01/06

Whittingham House 22/06/05

Whittingham House 03/12/04

Whittingham House 14/07/04

Whittingham House 10/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Whittingham House Whittingham Avenue Southend On Sea Essex SS2 4RH Lead Inspector Michelle Love Unannounced Inspection 3rd September 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whittingham House Address Whittingham Avenue Southend On Sea Essex SS2 4RH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01702 614999 01702 436536 whittingham24@tiscali.co.uk Strathmore Care Ms Marietta Masudo Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Old age, registration, with number not falling within any other category (50) of places Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th November 2006 Brief Description of the Service: Whittingham House cares for 50 older people, some who may additionally have dementia, in a residential area of Southend on Sea, close to local amenities and bus routes. The home is purpose built on two floors with a passenger lift to enable access to both levels. There are 44 single bedrooms and 3 double bedrooms, 35 of which have en suite facilities. The home has a large dining room, a variety of lounges and a garden area. The Statement of Purpose and Service Users Guide and a copy of the last inspection report are available within the main office. A copy of the Service User Guide is available in each resident’s bedroom. The current scale of charges ranged from £369.32 standard dependency to £410.48 high dependency. Extras charged are for hairdressing, chiropody, toiletries and newspapers etc. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection and was undertaken over a period of approximately 10 hours. The inspection was conducted with assistance from the home’s manager and with assistance of both senior and care staff working within Whittingham House. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. A partial tour of the premises was undertaken throughout various times of the day and included inspection of the newly constructed extension. During the visit residents and members of staff were spoken with and their comments are used throughout the report. Prior to the inspection 12 relatives surveys were forwarded to seek peoples’ views and it was positive to note that 7 surveys were completed and returned to the Commission for Social Care Inspection. Comments from these surveys are documented throughout the main text of the report. Some aspects of this service have failed to improve since the last inspection and these are highlighted within the agenda for action. An Annual Quality Assurance Assessment form was completed by the manager and submitted to the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 6 Improvements have been made to the pre admission assessment process and actual information recorded within individual pre admission assessments were observed to be much improved. Information recorded was detailed and informative and confirmed that the management team were able to meet the prospective person’s needs. The building work to complete a 27 bedded extension has continued to progress well and is near completion. Once completed (decorated and furnished) this will provide residents with a homely and comfortable place in which to live. What they could do better: There is little evidence to suggest that residents are enabled to actively participate and communicate their views with regard to the development of their care plans or their review. The staff team does not appear to understand the importance of involving residents in all aspects of their care. Additionally care staff do not appear to understand the concept of person centred care and the importance of delivering care in line with people’s individual care needs and the impact this has if not carried out. Procedures for the safe management of medication were poor and of concern and potentially placed residents at serious and unnecessary risk. Residents within the home must receive regular opportunities for stimulation and meaningful occupation in order for their social care needs to be met. In particular, the needs of those people with poor communication, poor cognitive development and those who are immobile, require further exploration and activities provided. The registered provider and manager must ensure that those residents who remain in their room are not isolated and left without staff support for long periods. Staffing levels and their deployment needs to be reviewed to make sure that residents do not experience undue delays when waiting for care or assistance from staff. Staff training in relation to several areas needs to be improved so as to ensure that staff, are competent to meet residents needs. Staff recruitment procedures must be robustly maintained to ensure residents are safeguarded. Please contact the provider for advice of actions taken in response to this Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Shortfalls in the written information available to people can potentially limit their informed choice about the home. Satisfactory assessments help to ensure that the team can meet the needs of potential residents before they move in. EVIDENCE: A copy of the homes Statement of Purpose and Service Users Guide was given to the inspector following the inspection. On inspection of both documents, neither was observed to contain the most up to date or accurate information about the services and/or facilities provided at Whittingham House. Both documents must be reviewed to enable prospective residents, their representatives and other interested parties to make an informed choice as to where to live. Attention must be paid to ensure that both documents refer Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 10 specifically to the range of needs that the care home is intended to meet (dementia). The home has a formal assessment process for assessing the needs of prospective residents prior to their admission to the care home. On inspection of two files for those most recently admitted to the care home documentation was observed to be detailed and informative. In addition to the management team’s pre admission assessment, information was provided from the individual’s placing authorities and/or hospitals. It was apparent from the assessment process that this had included the prospective resident and/or their representative where possible. On review of relative’s surveys, the majority indicated that on most occasions they are provided with sufficient information about the home, services and facilities. No evidence was available to confirm the registered provider had formally written to the resident and/or their representative to confirm it could meet the needs of the prospective person. This should be reviewed. The home does not provide intermediate care. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Gaps in the recording of care management means that there may be times where the needs of residents are not always met and the standard of care is basic. Aspects of medication administration at the home are unsatisfactory and could leave residents at risk. EVIDENCE: Care plans were sampled at random as part of this inspection. Care records evidenced that further development of the management team’s care planning and risk assessment processes is needed. Staff, need to ensure that individual resident’s needs are fully recorded and detail the interventions required so as to ensure that these are comprehensive. Information recorded within individual’s pre admission assessments should be transferred to the care plan document so as information is not lost and appropriately followed through as this could have a detrimental affect for the resident. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 12 Some areas of those care plans examined were noted to be generic, not person centred and actual delivery of care was not always provided by care staff in line with individual’s specific care needs. Identified shortfalls in care planning were discussed with the registered manager. This included the care plan for those residents who exhibit challenging behaviour. In some cases no information was recorded as to how this manifests, known triggers and little specific reference as to how residents should be supported by care staff in relation to their behaviours. Additionally the management team must consider how dementia and other conditions associated with older people impact on the individual person and their daily living skills. The management team need to ensure that individual residents’ healthcare needs are recorded in sufficient detail to evidence the care provided and to ensure residents’ wellbeing. Records also indicated that where residents are taking insufficient diet/fluids and require regular turning, these were not being completed consistently and there was little evidence to indicate that concerns were proactively being raised with healthcare professionals. Identifying individuals’ strengths and abilities needs to be developed so as to promote self worth. Records indicated that a range of healthcare professionals are available for residents and include GP’s, Consultant Psychiatry, Optician, Dentist, District Nurse Services etc. The majority of relative’s surveys recorded that the management team at the care home are proactive in dealing with individuals care needs if concerns are raised. However, one survey advised that they were surprised of one care issue, which was not dealt with by staff promptly until raised by the family and although a healthcare professional was contacted, the family was not advised of the outcome. The registered manager should consider ways of ensuring that systems are in place so that all relatives/representatives are kept informed of their relatives’ wellbeing and/or healthcare needs. Risk assessments were not devised for all areas of assessed risk. The home has a generic format, which does not contain sufficient detail identifying the specific area of risk to be minimised and staff’s interventions. Daily care records were generally written after every shift. Records varied in content and detail, with some records detailed and comprehensive, whilst other entries were vague and unclear. This requires reviewing so that consistency can be promoted amongst staff so that they provide sufficient detail on the actual care provided and how residents spend their day. Whilst we recognise that some members of staff have attained care planning training, the manager’s Annual Quality Assurance Assessment confirms that further training is required for “staff about writing care plans so as to ensure that residents receive the full and right care”. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 13 The storage facilities for medication were observed to be secure and satisfactory. A number of shortfalls relating to poor medication practices and procedures were highlighted at this inspection. This relates specifically to gaps in the Medicine Administration Records (MAR) whereby staff had not signed to indicate that medication had been administered to individual residents, medications not administered in accordance with the prescriber’s instructions and records of administration were not accurate and/or complete in some instances. Additionally one member of staff was observed to leave the medication trolley unattended for a period of time. All of the above practices must be addressed to ensure residents wellbeing and safety at all times. From discussions with the registered manager and from evidence of records, the manager was not aware of all instances whereby individual resident’s were refusing medication and she was unclear as to what steps were being taken by the management team to either seek advice from a healthcare professional or to proactively monitor the situation. It was positive to note that patient information sheets relating to individual medications used at the care home were readily available. The training plan provided to the inspector indicated some members of staff who administer medication do not have up to date medication training. This must be reviewed so as to ensure that staff, have the skills and competency to administer medication to people living at the care home. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for meaningful activity and occupation for those people living at Whittingham House are limited and not all residents have their social needs met. Meals for residents are satisfactory but some shortfalls in nutritional care could affect outcomes for residents. EVIDENCE: Activity assessment/record sheets were observed to be completed for all residents, however information did not include individual’s personal preferences, likes and dislikes. No planned activity programme had been devised and this was confirmed by the manager. The manager was advised that a programme depicting both `in house` and external activities to meet individual resident’s needs is needed, ideally in both a written and pictorial format, so as to enable residents to make an informed choice. On a notice board close to the main office there were some leaflets detailing information relating to South East Essex Advocacy for Older People, a local amateur dramatic group and clothing that can be Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 15 purchased from an external source. The Annual Quality Assurance Assessment completed by the manager detailed that it is hoped for a permanent staff member to be assigned the role of activities co-ordinator within the next 12 months. On the day of inspection, karaoke was undertaken during both the morning and afternoon. Some residents were observed to enjoy this activity, however little consideration is given to those people who have very limited or poor communication, sensory impairment, are immobile or who have acute dementia. The Annual Quality Assurance Assessment details under the heading of `what we could do better`, “to have more entertainments/activities” and it is hoped within the next 12 months for permanent staff assigned to organise more activities and outings. No evidence was available to indicate that this is actively being pursued. The registered manager should consider other activities such as enabling individuals to assist/get involved with day to day tasks around the care home (laying the table, folding napkins, making a bed etc.) so that individuals may gain a level of satisfaction, achievement and self worth. Additionally staff could consider putting together a memory box and/or life story-book for individual residents, which may help with drawing out memories and enable staff to engage with people. The home as an open visiting policy whereby residents residing at the care home can receive visitors at any reasonable time. Several visitors were observed to visit the care home on the day of inspection. Staff, were observed to have a good rapport with visitors. One visitor spoken with advised that they were always made to feel welcome by staff and confirmed that they could visit their member of family at any time. Relatives surveys confirmed this and stated, “staff always speak, smile and make one welcome” and “staff are always very helpful and always seem to make you welcome when you visit”. The home operates a four week rolling menu, which offers choice and a varied diet. In addition to the planned menu, residents are able to have alternatives. Meals provided to residents were seen to be plentiful and of good quality. Residents spoken with were complimentary regarding food provided with comments such as “the food is nice” and “oh it was lovely”. Those residents who require assistance from staff to eat their meals were supported sensitively and meals were not rushed. It was disappointing that some staff’s verbal interaction with individual residents was observed to be poor e.g. staff did not inform individual residents of the actual meal provided or offer verbal encouragement during the meal. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaint management in the home remains inadequate at times. Shortfalls were noted with regard to safeguarding and challenging behaviour training for staff, which could potentially put residents at risk. EVIDENCE: The home’s complaints procedure needs to be amended to reflect that the Commission for Social Care Inspection no longer has any statutory responsibility to investigate complaints. Relative’s surveys received at the CSCI office recorded that the majority of people knew how and to whom to complain too should the need arise, however there was evidence to indicate that some people were unclear of the procedure and/or process. On inspection of the manager’s complaint book, not all complaints had been recorded. In all instances, the registered provider has been requested to investigate matters and to provide a written response to the complainant. The manager was advised that the complaint records within the home need to clearly identify every complaint received at the care home, details of the actual investigation undertaken, action taken and the outcome. One safeguarding issue has been highlighted since the last inspection in relation to poor care practices and poor recording within care plan documentation. This was referred to the local authority and has been formally Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 17 investigated by social services, with recommendations and requirements made to the registered provider. On inspection of the home’s staff training plan, this indicated that not all staff had up to date training relating to safeguarding or training relating to managing aggression. Whilst we appreciate that staff receive some instruction relating to dealing with challenging behaviour within, the dementia training course provided, this area requires further development so as to ensure residents safety and wellbeing. Additionally as already stated, care plans do not provide clear guidelines/management strategies as to how to deal with individual’s behaviours, recording of specific incidents is poor in some cases and there is a lack of understanding by some staff as to how to deal effectively with individual resident’s. This was evident from those records examined. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment in the home is satisfactory for residents and they feel that it provides a homely atmosphere. The environment has been extensively renovated so as to improve and enhance the living conditions of those people who reside at the care home. EVIDENCE: The home is close to completing a large extension, which will provide an additional 27 bedrooms, additional communal space and include a 9 bedded dementia unit. The new building looks impressive and once fully fitted and decorated will provide residents with a pleasant place in which to live. The building work also includes some refurbishment of the existing building. One relative survey recorded “the care home could improve by completing the new building work that seems to be taking forever”. Another comment from a relative survey stated “the care home could improve if there was background Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 19 music where appropriate in the entrance area and corridors”. However, of those residents spoken with, all were complimentary regarding the home and comments such as “its lovely” and “I like my bedroom” were noted. Minor health and safety issues were highlighted at the start of the inspection, in relation to workmen leaving equipment and materials within easy access of residents. The registered provider was on site and asked workmen to ensure safe working practices. One area, which needs addressing, is in relation to one resident’s hot water supply. The relative survey recorded “We are told that the water takes a long time to come through but in our experience it can be up to 10 minutes with no sign of getting warm. The staff generally provide a bowl of hot water for my relative to wash with”. The registered provider/manager must ensure that a risk assessment is devised for the safe transportation of hot water to the resident’s room until the issue is promptly resolved. The front and rear gardens have been landscaped. The registered provider advised that further planting is to take place in the future and tables and chairs are to be purchased so that residents can enjoy sitting outside. On inspection of a random sample of resident’s bedrooms, all were seen to be personalised and individualised with many personal items displayed. Of those residents spoken with all were complimentary regarding their personal space. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The level of staffing on occasions restricts the ability of the service to deliver person centred care and to ensure residents needs, can be met and that they are safe. Current poor recruitment practices and training do not ensure that the needs of those residents living in the home are met. EVIDENCE: Staffing levels at Whittingham House are 7x staff between 08.00 a.m. and 20.00 p.m. and 4x waking night staff between 20.00 p.m. and 08.00 a.m. The manager advised, her hours are generally supernumerary to the roster Monday to Friday, however there are occasions whereby she is included in the main figures to cover annual leave, staff training commitments and/or sickness. Staff rosters for a four week period were inspected and evidence that staffing levels as stated above are not regularly maintained. This is detrimental for residents and potentially compromises their health, safety and general wellbeing. In relation to this there was evidence to show that residents were not being toileted regularly, the deployment of staff within the home was poor, especially on the first floor and residents who remain in bed or are immobile not regularly supported and left without assistance for long periods of time. One relative survey recorded “ They seem short staffed, some need a bit more Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 21 patience, especially when they dress and undress residents”. The Annual Quality Assurance Assessment completed by the manager confirms under the heading of `What we could do better`, “Adequate staffing levels to ensure safety at all times”. At this inspection several staff recruitment files were examined for those people newly recruited. The majority of records as required by regulation had been acquired, however the care file for one person who commenced employment recently did not include evidence of their completed application form, qualifications, experience and training, health declaration or written references. Additionally no record of induction had been started. Within the other employment files inspected, records of induction were available for 3 people, however these were not in line with Skills for Care. The Annual Quality Assurance Assessment specifies that it is envisaged in the next 12 months to implement a new and improve the current induction and supervision programs. Additionally the document details that more staff need to be recruited. The staff rosters for the past four weeks indicated on occasions that agency staff had been utilised at the care home. It was of concern that only 2 out of 6 agency staff profiles had been received at the care home, confirming their work experience, training and that all other checks had been undertaken by the agency before commencement of a shift at Whittingham House. No record of induction was available for any of the agency staff used at the care home. The registered manager was advised that this is not good practice and potentially places residents at risk. The manager’s training plan evidenced significant shortfalls in training for some staff and this related to manual handling, food hygiene, continence, basic first aid, fire safety, dementia awareness, infection control, health and safety and care planning. The management team at the home need to ensure that care staff have the necessary skills and competency so as to provide appropriate care to those people living at the care home. The training plan also detailed some staff had received training relating to nutrition, palliative care, pressure ulcers, diabetes, stroke care, stoma care and chair based activities. The management team must consider training for those conditions associated with older people. The home manager, deputy manager and 1 senior carer had received training on the Mental Capacity Act 2005. The above information which, was taken from the training plan submitted to the inspector did not concur with information recorded within the Annual Quality Assurance Assessment which stated under the heading of `What we do well`, “ on going staff training”. Records further indicate 5 members of staff had attained NVQ Level 2 and 2 members of staff had attained NVQ Level 3. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager continues to provide stability to the home. Shortfalls in some of the management systems at the home could adversely affect outcomes for residents. EVIDENCE: The manager has been at Whittingham House since July 1997 and as manager since 1999. The manager is a qualified RGN, has completed the D32/D33 assessor course and is undertaking a management course, which is due for completion in 2008. The training plan indicates the manager has undertaken a variety of other training courses necessary for her role. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 23 Comments from staff in relation to the management of the home were positive and the manager was observed to have a good relationship with her senior staff team. The manager demonstrated an easy manner with individual residents and demonstrated a good knowledge of individual’s needs. One relatives survey recorded “Overall, my opinion is that the home provides an efficient, caring service”. Another survey recorded “Whittingham House always strives to meet the needs of those who live in the care home and relatives” and “The care home seems well managed”. A random sample of records as required by regulation were inspected relating to fire drills, fire alarm system, emergency lighting, gas and electrical certificates, passenger lift certificate, hoist certificates and employers liability. All records were satisfactory. The manager advised the inspector of a system to ensure that all staff working within the home receive formal supervision, however she admitted that this is not as frequent as it should be and is not in line with National Minimum Standards recommendations. The registered manager was advised that formal supervision benefits staff as they can feel supported by the management team and have an opportunity to reflect on their professional practice, training opportunities and discuss any personal matters on a one to one basis. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X X 2 X 3 Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 and 5 Requirement Timescale for action 01/02/08 2. OP7 15(1) Ensure that the Statement of Purpose and Service Users Guide is reviewed and updated to reflect accurately the services and facilities provided at the care home so that prospective residents and other interested parties can make an informed choice. Ensure that care plans are 01/02/08 detailed and comprehensive and clearly reflect how the needs of residents are to be met and residents supported so as to enable staff to deliver appropriate care. Previous timescale of 31.3.07 not met. Ensure that risk assessments are 01/02/08 devised for all areas of assessed risk and there are clear guidelines depicting how these are to be minimised for residents. Ensure that medication is 03/09/07 recorded and administered safely and appropriately to residents so as to ensure their safety and DS0000015486.V350634.R01.S.doc Version 5.2 3. OP7 13(4) 4. OP9 13(2) Whittingham House Page 26 5. OP9 12(1) 6. OP12 16(m) and (n) wellbeing. Residents must be given medication in accordance with the prescriber’s instructions so as to ensure that they receive the correct treatment prescribed for them. Ensure that a programme of activities is provided that meets the individual and group needs of residents, taking into account their personal preferences, likes and dislikes. 03/09/07 01/03/08 7. OP18 13(6) 8. OP27 18(1)(a) Previous timescale of 31.3.07 not met. Ensure that both senior and care 01/04/08 staff receive training relating to safeguarding and challenging behaviour so as to ensure residents needs can be met and that staff are aware of current good practice. Ensure that at all times there are 03/09/07 staff working in the home in such numbers as are appropriate for the dependency, health and welfare of the residents. Previous timescale of 31.3.07 not met. Ensure that records as required by regulation are available for inspection and that all staff whether permanent or agency are robustly recruited so as to safeguard residents. Ensure that all staff receive appropriate training to the work they perform so that their practice is up to date and protects residents. This refers specifically to dementia awareness, fire safety, manual handling, food hygiene, infection control and health and safety. Ensure that all staff receive regular supervision. DS0000015486.V350634.R01.S.doc 9. OP29 19 03/09/07 10. OP30 18(1)(c) and (i) 01/04/08 11. OP36 18(2) 03/09/07 Page 27 Whittingham House Version 5.2 Previous timescale of 31.3.07 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP7 OP8 OP9 OP9 OP16 OP28 Good Practice Recommendations Daily care records should record how residents spend their day, staff’s interventions and outcomes for residents. Nutritional records and `turn charts` should be completed consistently and in line with individual resident’s care plans/care needs. PRN (as and when required medication) protocols should be devised. The list of staff deemed competent to administer medication should be reviewed and updated. The complaints procedure should be amended to reflect the CSCI no longer has any statutory responsibility to investigate complaints. 50 of care staff should have an NVQ qualification. Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Whittingham House DS0000015486.V350634.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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